Prospective study of revision and surgical stabilization of symptomatic non-union chest wall injuries
Eva-Corina Caragounis, Ragnar Ang, Erik Öberg WestinAbstract
Introduction
Traumatic chest wall injuries are common and expected to heal within three months although some patients may experience painful non-union fractures. Previous studies, mostly retrospective, suggest that surgical management may be beneficial in selected patients. The objective of the study is to evaluate clinical outcome after surgical revision and stabilization of symptomatic nonunion fractures in the chest wall.
Methods
This is a prospective study of adult patients undergoing revision and plate fixation of symptomatic nonunion fractures in the chest wall. The primary endpoint was lung function. Patients answered standardized questionnaires concerning symptoms, QoL, work activity and underwent a post-operative CT after six months.
Results
Fourteen patients (11 male and 3 female), with mean age 57.9 ± 11.5 and 33 non-union fractures in the chest wall (26 ribs, 6 chondral and 1 sternum) were included. The majority were non-smokers (n = 12). Median predicted FVC improved from 93% to 98% (P = 0.266). After six months 86% were satisfied with the surgery, 79% felt the operation had helped them and experienced a decrease in symptoms. However 43% had remaining symptoms. Usage of pain medication decreased from 50% to 21% (P = 0.250). Median EQ5D VAS increased from 63% to 85% (P = 0.007). There was no difference in the number of patients working pre-operatively and after six months (n = 11). CT after six months showed 71% of fractures healed.
Discussion
We found no statistically significant improvement in postoperative lung function. Surgical revision and stabilization of symptomatic non-union fractures in the chest wall show promise in decreasing patient symptoms and improving quality of life.